胃蛋白酶原亚群测定与萎缩性胃炎相关性研究及效价比分析

Studies on Relationship of Atrophicgastritis and Pepsinogen Subtypes and Effect-Cost Ratio

目的:研究血清中胃蛋白酶原(pepsinogen)亚群(PGⅠ、PGⅡ)含量在健康体检者及胃部疾病患者中的水平,探讨血清中PG亚群测定对萎缩性胃炎及胃癌早期诊断的意义。方法:利用放射免疫法(RIA)测定35例健康体检者、18例胃溃疡患者、30例萎缩性胃炎患者、30例胃癌患者中PGⅠ、PGⅡ及PGⅠ/PGⅡ值的变化,在正常组(健康体检者)与各疾病组之间进行统计学比较,并比较胃蛋白酶原检测与胃镜和(或)病理检查费用的效价比。结果:(1)与正常组相比,消化性溃疡患者PGⅠ、PGⅡ升高,且PGⅡ增高明显,PGⅠ/PGⅡ比值降低;萎缩性胃炎组和胃癌组PGⅠ水平均呈下降趋势,但PGⅡ水平变化不明显,PGⅠ/PGⅡ比值下降。(2)与溃疡组相比,萎缩性胃炎和胃癌患者PGⅠ、PGⅡ及PGⅠ/PGⅡ比值均明显降低。(3)与萎缩性胃炎组相比,胃癌患者PGⅠ、PGⅡ及PGⅠ/PGⅡ比值虽略低于萎缩性胃炎,但差异无统计学意义。(4)PGⅠ≤80ng/mL且PGⅠ/PGⅡ≤6时,检出萎缩性胃炎的特异度和灵敏度分别为94.3%和53.3%。结论:(1)血清PGⅠ和PGⅠ/PGⅡ比值的降低,是萎缩性胃炎及胃癌人群筛查和辅助诊断的一项血清学指标。(2)血清PGⅠ≤80ng/mL且PGⅠ/PGⅡ≤6检测萎缩性胃炎具有较好的特异度和灵敏度。(3)测定血清中PG亚群的方法简单易行,适用于初筛及胃镜检查禁忌者,且与直接行胃镜并取病理检查相比较为经济。

Objective： To study variation of Serum pepsinogen subgroups （pepsinogen, PGⅠ , PG Ⅱ ） content in healthy persons and patients with stomach diseases, and investgate serum pepsinogen subgroups （pepsinogen, PG Ⅰ , PG Ⅱ ） content for significant of early diagnosis of atrophic gastritis and gastric cancer. Methods： The changes of PG Ⅰ , PG Ⅱ and the PG Ⅰ /PG Ⅱ with radioimmunoassay （RIA） were measured in healthy persons, gastric ulcer, chronic atrophic gastritis and gastric cancer patients. The normal control group and every disease group were statistically compared. Results： （ 1 ） Compared with the normal control group, the content of serum PG Ⅰ in atrophic gastritis and gastric cancer patients were decreasing （P 〈0.05）, and the ratio of PG Ⅰ / PG Ⅱ was also decreasing, but the content of serum PG Ⅱ did not change significantly. （2） Compared with the peptic ulcer patients, the content of serum PG Ⅰ , PG Ⅱ and the ratio of PG Ⅰ / PG Ⅱin atrophic gastritis and gastric patients cancer decreased significantly （P 〈0.05）. （3） Compared with the atrophic gastritis patients, the content of PG Ⅰ, PG Ⅱ and the ratio of PG Ⅰ / PG Ⅱ in gastric cancer patients was slightly lower, but the difference was not statistically significant. （4） When PG I ≤80 ng/mL and the PG Ⅰ /PG Ⅱ -〈6, the sensitivity and specificity for detection of atrophic gastritis are 53.3% and 94.3%.Conclusion： （1） The content of serum PG Ⅰ and the ratio of PG Ⅰ / PG Ⅱ are serum markers for screening and supplementary diagnosis of atrophic gastritis and gastric cancer. （2） The serum PG Ⅰ and PG Ⅰ / PG Ⅱ decreasing are risk factors for atrophic gastritis, which may be as a screening and supplementary diagnosis serum markers in local people. （3）. This method is simple and easy to operate and suitable for screening, and save the country＇s medical resources.